Healthcare Provider Details

I. General information

NPI: 1265365340
Provider Name (Legal Business Name): COASTAL COMFORT HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N KILLIAN DR STE 210C
LAKE PARK FL
33403-1961
US

IV. Provider business mailing address

1151 LAKE TERRY DR APT I
WEST PALM BEACH FL
33411-9287
US

V. Phone/Fax

Practice location:
  • Phone: 561-662-2503
  • Fax:
Mailing address:
  • Phone: 561-662-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. XAVIER DEON BRYANT JR.
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 561-662-2503